Begin Form
Position(s) you are applying for: (Type in volunteer if applying for a volunteer position)

Full Name

E-mail address (Required)

Present Mailing Address

Present Phone w/ Area Code

Cell Phone with Area Code

City	State	Zip

Permanent Mailing Address

Permanent Phone w/ Area Code

Permanent City	State	Zip

Country

Do You have a Drivers License?	State	Class
Yes No

Are you over 18?	Are You?
Yes	male
No	female

Best time to call (am/pm):

Days

M T W Th F S Su

Dates Available for Employment or volunteer position.

From:

To:

Education

	Name and City/State:	Dates:	Highest Grade Completed:	Degree/Major:
High School:
College:

Employment Experience
(List most recent experience first)

1. Employer's name:

Employer's Address

Employer's Phone

City	State	Zip

Position:
Supervisor's Name:

Reason for leaving:

Dates employed (from - to):

Major responsibilities:

2. Employer's name:

Employer's Address

Employer's Phone

City	State	Zip

Position:
Supervisor's Name:

Reason for leaving:

Dates employed (from - to):

Major responsibilities:

3. Do we have your permission to contact current or past employers?
Yes
No

If No, explain:


Counseling Skills:
Please describe any experience in working with children and adults with disabilities:

Supervisory or Leadership Skills:

Have you had any experiences dealing with behavioral problems?

At this time, what are your career goals?

Skills and Activities:
In the following list, please put check box for activities you can teach/organize or
those you can assist. Leave blank if no experience.

Camp Store Yes No
American Sign Language? Yes No
Basic Computer Skills? Yes No

Certificates:
There are mandatory license/certificates for nurses, drivers and lifeguards. Proof of these credentials must be provided before a contract will be offered. Please list any documentation (i.e. CPR, Commercial Drivers License, Lifesaving, First Aid or Nursing License).
Certifications - Date Received - Date Expires

Staff members are expected to arrive for staff training and stay until the last day of camp. Some arrangements can be made for those who are unable to stay the entire time. Will you be available to work a full season, (11 weeks)?
(Summer staff only.)
Yes
No

If no, please explain:

Please Answer the Following:
1. Why do you want to work at Camp Krem? (Summer staff only.)

2. The positions at camp may include some lifting and moving (up to 30 pounds), vigorous activities, and long hours. Are there any reasons why you might have difficulty performing any of the essential elements of the job for which you are applying? (Summer staff only.)
Yes
No

If yes, what:

3. Have you been convicted of a crime other than a minor traffic offense?
Yes
No

If yes, describe in full:

4. Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse?
Yes
No

If yes, describe in full:

5. Have your parental rights ever been terminated for reasons involving sexual or physical abuse?
Yes
No

If yes, describe in full:

6. The camp's policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, all other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to workplace harassment?
Yes
No

If yes, describe in full:

7. I heard about Camp Krem from:

	Referred by:
	School Placement Office
	Web Page
	Monster.com/JobTrak
	ACA
	Other (please explain):

I have read everything in the above application, and I fully understand this information.